This proposal examines the effectiveness of an electronic reminder system and a physician education program to increase the rates of colon cancer screening in a large network of primary care physicians, the University of Utah Community Clinics. We will: 1) implement a second-generation electronic prompt system in the network together with patient care system changes to maximize the effectiveness of this prompting; 2) institute a comprehensive educational program on colon cancer screening for network physicians; and then, 3) compare resultant screening rates to pre-study rates in the network as well as to community screening rates determined from several sources. The study setting involves over 50 primary care physicians and 20 mid-level providers linked by an electronic medical record (EMR) within a six-practice primary care network. The network provides care to over 100,000 patients of diverse demographic and ethnic background in and around Salt Lake City, Utah. A central feature of the project will be implementation of a computerized reminder system that prompts clinicians to offer CRC screening to appropriate patients and then tracks the results of all tests completed. The reminder system will be complemented by an extensive physician education program on colon cancer screening as well as implementation of screening in the practice setting of a culturally and ethnically diverse population. The project is designed as a Quality Improvement (QI) investigation directed at changing physician behavior. Thus, to support the electronic prompt system, we will institute a variety of complementary changes to the overall patient care process. These changes will be implemented using the QI process of frequent, rapid-cycle trials of individual improvements, with continuous monitoring via Statistical Process Control (SPC) to detect the impact of improvements on CRC screening rates and outcomes. This approach will enable derivation of key principles of best practice in this network as a basis to disseminate a package of such process improvements to a larger group of other medical practices in anticipated follow-on investigation.